To investigate the influence of
antihypertensive therapy and the success of blood pressure control on
coronary heart disease incidence and total mortality, we studied dyslipidemic middle-aged men participating in the placebo arm of the Helsinki Heart Study, a randomized coronary primary prevention trial with
gemfibrozil. Based on blood pressure level and the presence of
antihypertensive therapy at study entry, the participants were classified into four categories. Relative risks of
coronary heart disease (nonfatal
myocardial infarction or
cardiac death) and total mortality during the 5-year trial period were calculated using Cox proportional hazards models. With subjects who were not using
antihypertensive drugs and who had normal blood pressure (category I) as reference, the relative risks of
coronary heart disease during the trial period were 2.1 (95% confidence interval [CI], 1.3 to 3.3) in untreated hypertensive subjects (category II), 0.9 (95% CI, 0.2 to 3.8) in subjects with successful
antihypertensive therapy (category III), and 2.0 (95% CI, 1.0 to 4.1) in subjects who remained hypertensive despite
drug therapy (category IV). The relative risks of death were 1.9 (95% CI, 0.9 to 3.9) in category II and 1.0 (95% CI, 0.1 to 7.3) in category III; in category IV subjects, those with unsuccessful
antihypertensive therapy, the relative risk was 4.4 (95% CI, 2.0 to 9.6). The excess mortality in this category was due to cardiovascular causes and was clustered in subjects with multiple
drug therapy for
hypertension control. We conclude that successful
antihypertensive therapy in dyslipidemic men reduced
coronary heart disease incidence despite its adverse effects on
high-density lipoprotein cholesterol and
triglycerides.(ABSTRACT TRUNCATED AT 250 WORDS)